Childbirth in a country practice: a sometimes risky business

Leongatha Hospital is served by a small number of GP Obstetricians (Photo: David McAlpine)

Expectant mothers in many small rural communities lack much-needed access to specialist doctors in the field of pregnancy and childbirth, experts say.

While pregnancy is an exciting time for mothers, it can be terrifying for those experiencing complications, particularly in rural areas distanced from large metropolitan or regional hospitals with specialist expertise and facilities.

In Leongatha, a town of 5000 people 135 kilometres south-east of Melbourne, a small team of five General Practitioners are qualified to provide obstetric care for low to medium risk patients.

High-risk patients must travel to the nearest regional centre to visit specialist obstetricians because Leongatha does not offer regular visiting consultations.

Leongatha mother Helen Pickering is expecting her second child and is concerned with the lack of specialist obstetricians, particularly the perils of travelling to a larger regional hospital if complications arise.

“It’s obviously becoming an issue because there’s no specialist there in the last week of my pregnancy, when things could go wrong,” she said.

The birth of her first child 10 years ago involved a last-minute complication requiring the local doctors to reposition the baby and deliver using “cups”, to avoid a posterior birth.

The alternative, a Caesarean birth, would have required a specialist anaesthetist to travel almost an hour from the Latrobe Valley to assist.

Ms Pickering said the risk of stillbirth and other complications with her second child is heightened because of her age, however the absence of other risk factors means specialist involvement throughout the pregnancy had not been necessary.

Instead, the GP team has recommended more regular appointments and ultrasounds for Ms Pickering, with the option of inducing the birth a week earlier to reduce potential risks.

Leongatha Healthcare GP Obstetrician Dr Elise Ly said a specialist obstetrician would only travel from another area in extreme circumstances.

“The reality of Australia is you can’t have everyone living close to a tertiary centre,” Dr Ly said.

Local doctors with training in obstetrics care say they provide a valuable service to their rural community (Photo: David McAlpine)

The Leongatha Hospital delivers about 200 babies a year and provides an operating theatre for the one in five births that by Caesarean section.

GP Obstetrician Dr Sewellyn Gale said pathology and radiology services are available but the hospital lacks a special care nursery for critically ill babies and access to extra blood products.

Dr Ly said the GP obstetrician qualification, which trains general practitioners in primary obstetrics care, ensures they are prepared not only for regular births but also for managing complications and emergencies.

“That’s sort of the expected standard, that if you’re going to provide an obstetrics service and if you’re going to provide theatre services, the people that are providing the services need to be trained in some sort of ‘first aid’ for obstetrics emergencies, before being transferred,” Dr Ly said.

Dr Gale said the service could only provide short-term urgent care for more complex obstetrics emergencies, such as pre-term babies, requiring a specialist obstetrician and more advanced facilities.

“It depends on the level of complexity. So the next step after us would be the regional centres at Traralgon and Warragul,” Dr Gale said.

If it is beyond the capabilities of the nearest regional hospitals, patients are transferred to Melbourne, often to Monash Medical Centre.

GP Obstetrician Dr Joel Fanning said they have to take extra precaution when transferring women in emergency care to a regional hospital because of the potential for complications while being relocated, as well as possible delays if an ambulance is not immediately available.

“You have to take into account the potential for her to progress on the road, so it might be safer to deliver the baby here than to have her delivering in the ambulance on the way over to one of those services,” he said.

Dr Fanning said patient satisfaction remains high because the local service provides individualised care, unlike hospitals in metropolitan areas in which patients may become “lost in the system”.

“The personalised element is wonderful. As health professionals, we enjoy that and I think that the patients enjoy it as well because they have continuity of care,” Dr Fanning said.

“Without bagging the tertiary centres, I think that from my point of view and I think from my patients’ point of view, they have a high level of satisfaction because of the personalised care,” he said.

Dr Ly said there is not a one-size-fits-all solution to obstetrics care.

“I don’t think we’re bagging anyone out, I just think there’s pros and cons of big hospital systems and smaller hospital systems, and being aware of them both means that you can address them,” Dr Ly said.

In order to improve rural maternity services, Dr Fanning said more funding should be directed towards GP obstetricians, particularly to cover after hours work.

“It should be highly valued by the people deciding how much medical staff are remunerated,” Dr Fanning said.

David McAlpine is studying a Science and Arts double degree at Monash University and is a freelance science and health journalist. He tweets as @dreamingscience

This article was first published by Mojo News, Monash Journalism’s online magazine www.mojonews.com.au